• Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct. 69 p. [138 references]

Does not apply to this measure

This measure is used to assess the percentage of patients with acute myocardial infarction (AMI) receiving thrombolytics with a "door-to-drug time" (time from presentation to administration of drug) of less than 30 minutes.

The priority aim addressed by this measure is to minimize the delay in administering thrombolytics to patients with acute myocardial infarction (AMI).

Acute myocardial infarction (AMI); thrombolytics; "door-to-drug time" (time from presentation to administration of drug)

Number of patients with acute myocardial infarction (AMI) receiving thrombolytics in the emergency department in the measurement period

Number of patients with acute myocardial infarction (AMI) receiving thrombolytics within 30 minutes of presentation in the emergency department (All reportable "door-to-drug times"* are rounded to the nearest minute.)

*Formula for calculating "door-to-drug time": Time of initiation of thrombolytic therapy to patient with AMI - Time of arrival of patient with AMI in the emergency department = Door-to-drug time in minutes

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement

Emergency Medical Services
Hospitals

Physicians

Group Clinical Practices

Age greater than or equal to 18 years

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Getting Better

Effectiveness
Timeliness

Users of care only

Adults 18 and older diagnosed as having an acute myocardial infarction (AMI)

It is suggested that data collection be completed on a real-time basis. This measure references all patients to improve process sensitivity at sites where few AMI patients are routinely discharged in a given measurement period.

Should real-time data collection present insurmountable institutional obstacles, consider using the following principal diagnosis codes (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) for identification of patient records for abstracting:

• 410 - AMI, with or without first decimal extensions in the set (0,1,2,3,4,5,6,7,8,9); as well as second decimal extensions in the set (0 or 1 only).

In addition to tracking the percentage of patients treated in less than 30 minutes, sites may choose to also track either the mean (average) or the median (middle point) of the data. Using the median is preferred. The median is the value of the middle item in the data set. The median value is preferred over the mean (average) value because it minimizes the impact of outlying data points.

For example, if one case of receiving thrombolytics took 120 minutes when the other 10 cases in the data set received them within 20 to 30 minutes, the mean would be about 34 minutes. However, the median for that same data set might be around 26 minutes, and would more accurately reflect the usual performance of the system.

Data can be collected weekly or monthly.

Patients associated with provider

Inclusions
Number of patients with acute myocardial infarction (AMI) receiving thrombolytics in the emergency department in the measurement period

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Encounter
Therapeutic Intervention

Time window is a single point in time

Inclusions
Number of patients with acute myocardial infarction (AMI) receiving thrombolytics within 30 minutes of presentation in the emergency department (All reportable "door-to-drug times"* are rounded to the nearest minute.)

*Formula for calculating "door-to-drug time": Time of initiation of thrombolytic therapy to patient with AMI - Time of arrival of patient with AMI in the emergency department = Door-to-drug time in minutes

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of patients with AMI receiving thrombolytics with a "door-to-drug time" (time from presentation to administration of drug) of less than 30 minutes.

Institute for Clinical Systems Improvement

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne, and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

Work Group Members: R. Scott Wright, MD (Work Group Leader) (Mayo Clinic) (Cardiology); Paul Spilde, PT (Park Nicollet Health Services) (Cardiac Rehabilitation); James Morrison, MD (HealthPartners Medical Group) (Cardiology); M. Danish Rizvi, MD (HealthPartners Medical Group) (Cardiology); Jackson Thatcher, MD (Park Nicollet Health Services) (Cardiology); Editha Liu, MD (Avera Health) (Hospitalist); Tonja Larson, PharmD, BCPS (Marshfield Clinic) (Pharmacy); Kathy Melsha, PharmD, BCPS (Park Nicollet Health Services) (Pharmacy); Myounghee Hanson (Institute for Clinical Systems Improvement) (Facilitator); Teresa Hunteman, MA, CPHQ (Institute for Clinical Systems Improvement) (Facilitator)

Measure was not adapted from another source.

2004 Nov

2008 Oct

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Oct. 76 p.

• Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct. 69 p. [138 references]

This NQMC summary was completed by ECRI on February 25, 2005. This NQMC summary was updated by ECRI Institute on December 29, 2005, January 24, 2007, and again on February 19, 2009.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.